Amalgam: Eine Risikobewertung unter Berücksichtigung der neuen Literatur bis 2005

Zusammenfassung

Amalgam, welches weltweit seit 150 Jahren als Zahnfüllmaterial verwendet wird, besteht aus etwa 50 % elementarem Quecksilber und einer Mischung aus Silber, Zinn, Kupfer und Zink. Aus fertigen Amalgamfüllungen werden kontinuierlich kleine Mengen an Quecksilberdampf freigesetzt. Amalgam trägt dabei signifikant zur menschlichen Quecksilberbelastung bei. Quecksilber kann in Organen, insbesondere im Gehirn akkumulieren, da die Bindung zu Proteinen stärker als die von anderen Schwermetallen (z. B. Blei, Kadmium) ist. Im Gehirn werden Halbwertszeiten von 1 - 18 Jahren angenommen. Quecksilber gilt als eines der giftigsten nichtradioaktiven Elemente. Es bestehen Hinweise darauf, dass Quecksilberdampf stärker neurotoxisch wirkt als Methyl-Quecksilber aus Fisch. Neuere Publikationen weisen auf das Risiko von Nierenschädigungen, neuropsychologischen Beeinträchtigungen, Induktion von Autoimmunerkrankungen oder Sensibilisierungen, gesteigerte oxidative Belastung, Autismus, Haut- und Schleimhautreaktionen und unspezifische Beschwerden durch Amalgamexposition hin. Auch die Alzheimer-Erkrankung oder die Entwicklung einer MS wird z. T. mit einer Quecksilberexposition in Zusammenhang gebracht. Es bestehen, möglicherweise erblich bedingt oder erworben, unterschiedliche interindividuelle Empfindlichkeiten zur Entstehung von negativen Effekten durch Amalgambelastungen. Quecksilbermessungen in Biomarkern sind aufgrund fehlender Korrelation zu den Quecksilberkonzentrationen in den Organen nur bedingt zur Abschätzung der Quecksilberbelastung der kritischen Organe geeignet. Wegen methodischer Mängel sind manche Amalgamstudien in ihren Aussagen nur bedingt verwertbar. Eine Amalgamentfernung konnte in einigen Studien bei einem relevanten Teil der Patienten zur dauerhaften Verbesserung oder Heilung verschiedener und meistens chronischer Beschwerden führen. Aufgrund der Berücksichtigung aller verfügbaren Daten kann Amalgam weder medizinisch, arbeitsmedizinisch noch ökologisch als sicheres Zahnfüllungsmaterial bezeichnet werden.

Abstract

Amalgam, which has been in use in dentistry for 150 years, consists of 50 % elemental mercury and a mixture of silver, tin, copper and zinc. Minute amounts of mercury vapour are released continuously from amalgam. Amalgam contributes substantially to human mercury load. Mercury accumulates in some organs, particulary in the brain, where it can bind to protein more tightly than other heavy metals (e. g. lead, cadmium). Therefore, the elimination half time is assumed to be up to 1 - 18 years in the brain and bones. Mercury is assumed to be one of the most toxic non-radioactive elements. There are pointers to show that mercury vapour is more neurotoxic than methyl-mercury in fish. Review of recent literature suggests that mercury from dental amalgam may lead to nephrotoxicity, neurobehavioural changes, autoimmunity, oxidative stress, autism, skin and mucosa alterations or non-specific symptoms and complaints. The development of Alzheimer’s disease or multiple sclerosis has also been linked to low-dose mercury exposure. There may be individual genetical or acquired susceptilities for negative effects from dental amalgam. Mercury levels in the blood, urine or other biomarkers do not reflect the mercury load in critical organs. Some studies regarding dental amalgam reveal substantial methodical flaws. Removal of dental amalgam leads to permanent improvement of various chronic complaints in a relevant number of patients in various trials. Summing up, available data suggests that dental amalgam is an unsuitable material for medical, occupational and ecological reasons.

Amalgam - Quecksilber - Toxizität - Nebenwirkungen - Autoimmunität - Neurodegenerative Krankheiten

Amalgam - mercury - toxicity - adverse health effects - autoimmunity - neurodegenerative diseases

Literatur

• 1 Nickolaus B. Einen sanften Ausstieg vorbereiten.  Deutsches Ärzteblatt. 1995;  92 1/2
• 2 Kommission Human-Biomonitoring des Umweltbundesamtes . Stoffmonographie Quecksilber - Referenz- und Human-Biomonitoring-Werte (HBM).  Bundesgesundhbl. 1999;  42 522-532
• 3 van Steenkiste M, Becher A, Banschbach R. et al . Prevalence of Caries, Fissure Sealants and Filling Materials among German Children and Children of Migrants.  Gesundheitswesen. 2004;  66 754-758
• 4 Gabrio T, Benedikt G, Broser S. et al . 10 years of observation by public health offices in Baden-Wurttemberg - assessment of human biomonitoring for mercury due to dental amalgam fillings and other sources.  Gesundheitswesen. 2003;  65 327-335
• 5 Tiffany-Castiglion E, Qian Y. Astroglia as metal depots: molecular mechanisms for metal accumulation, storage and release.  Neurotoxicology. 2001;  22 577-592
• 6 Lorscheider F L, Vimy M J, Summers A O. Mercury exposure from „silver” tooth fillings: emerging evidence questions a traditional dental paradigm.  FASEB J. 1995;  9 504-508
• 7 Arvidson B. Inorganic mercury is transported from muscular nerve terminals to spinal and brainstem motoneurons.  Muscle Nerve. 1992;  15 1089-1094
• 8 Arvidson B. A review of axonal transport of metals.  Toxicology. 1994;  88 1-14
• 9 Arvidson B, Arvidsson J. Retrograde axonal transport of mercury in primary sensory neurons innervating the tooth pulp in the rat.  Neurosci Lett. 1990;  115 29-32
• 10 Arvidson B, Arvidsson J, Johansson K. Mercury deposits in neurons of the trigeminal ganglia after insertion of dental amalgam in rats.  Biometals. 1994;  7 261-263
• 11 Stortebecker P. Mercury poisoning from dental amalgam through a direct nose-brain transport.  Lancet. 1989;  1 1207
• 12 Pamphlett R, Coote P. Entry of low doses of mercury vapor into the nervous system.  Neurotoxicology. 1998;  19 39-47
• 13 Tjalve H, Henriksson J. Uptake of metals in the brain via olfactory pathways.  Neurotoxicology. 1999;  20 181-195
• 14 Akyuz S, Caglar E. Pulpal uptake of mercury from lined amalgam restorations in guinea pigs.  Eur J Oral Sci. 2002;  110 460-463
• 15 WHO (World Health Organisation) (ed) .Environmental Health Criteria 118: Inorganic mercury. Geneva; 1991
• 16 Danscher G, Horsted-Bindslev P, Rungby J. Traces of mercury in organs from primates with amalgam fillings.  Exp Mol Pathol. 1990;  52 291-299
• 17 Galic N, Prpic-Mehicic G, Prester L. et al . Dental amalgam mercury exposure in rats.  Biometals. 1999;  12 227-231
• 18 Galic N, Prpic-Mehiic G, Prester L J. et al . Elimination of mercury from amalgam in rats.  J Trace Elem Med Biol. 2001;  15 1-4
• 19 Hahn L J, Kloiber R, Leininger R W. et al . Whole-body imaging of the distribution of mercury released from dental fillings into monkey tissues.  FASEB J. 1990;  4 3256-3260
• 20 Hahn L J, Kloiber R, Vimy M J. et al . Dental „silver” tooth fillings: a source of mercury exposure revealed by whole-body image scan and tissue analysis.  FASEB J. 1989;  3 2641-2646
• 21 Lorscheider F L, Vimy M J. Mercury exposure from „silver” fillings.  Lancet. 1991;  337 1103
• 22 Vimy M J, Takahashi Y, Lorscheider F L. Maternal-fetal distribution of mercury (203Hg) released from dental amalgam fillings.  Am J Physiol. 1990;  258 939-945
• 23 Barany E, Bergdahl I A, Bratteby L E. et al . Mercury and selenium in whole blood and serum in relation to fish consumption and amalgam fillings in adolescents.  J Trace Elem Med Biol. 2003;  17 165-170
• 24 Barregard L, Svalander C, Schutz A. et al . Cadmium, mercury, and lead in kidney cortex of the general Swedish population: a study of biopsies from living kidney donors.  Environ Health Perspect. 1999;  107 867-871
• 25 Becker K, Kaus S, Krause C. et al . German Environmental Survey 1998 (GerES III): environmental pollutants in blood of the German population.  Int J Hyg Environ Health. 2002;  205 297-308
• 26 Becker K, Schulz C, Kaus S. et al . German Environmental Survey 1998 (GerES III): environmental pollutants in the urine of the German population.  Int J Hyg Environ Health. 2003;  206 15-24
• 27 Drasch G, Schupp I, Hofl H. et al . Mercury burden of human fetal and infant tissues.  Eur J Pediatr. 1994;  153 607-610
• 28 Drasch G, Schupp I, Riedl G. et al . Einfluß von Amalgamfüllungen auf die Quecksilberkonzentration in menschlichen Organen.  Dtsch Zahnärztl Z. 1992;  47 490-496
• 29 Drasch G, Wanghofer E, Roider G. Are blood, urine, hair, and muscle valid bio-monitoring parameters for the internal burden of men with the heavy metals mercury, lead and cadmium?.  Trace Elem Electrolytes. 1997;  14 116-123
• 30 Eggleston D W, Nylander M. Correlation of dental amalgam with mercury in brain tissue.  J Prosthet Dent. 1987;  58 704-707
• 31 Gottwald B, Traenckner I, Kupfer J. et al . Gieler „Amalgam disease” - poisoning, allergy, or psychic disorder?.  Int J Hyg Environ Health. 2001;  204 223-930
• 32 Guzzi G, Grandi M, Cattaneo C. Should amalgam fillings be removed?.  Lancet. 2002;  360 2081
• 33 Mortada W I, Sobh M A, El-Defrawy M M. et al . Mercury in dental restoration: Is there a risk of nephrotoxicity?.  J Nephrol. 2002;  15 171-176
• 34 Nylander M. Mercury in pituitary glands of dentists.  Lancet. 1986;  1 442
• 35 Nylander M, Friberg L, Lind B. Mercury concentrations in the human brain and kidneys in relation to exposure from dental amalgam fillings.  Swed Dent J. 1987;  11 179-187
• 36 Nylander M, Weiner J. Mercury and selenium concentrations and their interrelations in organs from dental staff and the general population.  Br J Ind Med. 1991;  48 729-734
• 37 Pizzichini M, Fonzi M, Giannerini F. et al . Influence of amalgam fillings on Hg levels and total antioxidant activity in plasma of healthy donors.  Sci Total Environ. 2003;  301 43-50
• 38 Weiner J A, Nylander M. The relationship between mercury concentration in human organs and different predictor variables.  Sci Total Environ. 1993;  138 101-115
• 39 Zimmer H, Ludwig H, Bader M. et al . Determination of mercury in blood, urine and saliva for the biological monitoring of an exposure from amalgam fillings in a group with self-reported adverse health effects.  Int J Hyg Environ Health. 2002;  205 205-211
• 40 Kingman A, Albertini T, Brown L J. Mercury concentrations in urine and whole blood associated with amalgam exposure in a US military population.  J Dent Res. 1998;  77 461-471
• 41 Mutter J, Naumann J. Mercury and the risk of myocardial infarction.  N Engl J Med. 2003;  348 2151-2154
• 42 Drasch G, Muller R K, Grasemann F. et al . Comparison of the body burden of the population of Leipzig and Munich with the heavy metals cadmium, lead and mercury - a study of human organ samples.  Gesundheitswesen. 1994;  56 263-267
• 43 Ask K, Akesson A, Berglund M. et al . Inorganic mercury and methylmercury in placentas of Swedish women.  Environ Health Perspect. 2002;  110 523-526
• 44 Holmes A S, Blaxill M F, Haley B E. Reduced levels of mercury in first baby haircuts of autistic children.  Int J Toxicol. 2003;  22 277-285
• 45 Morgan D L, Chanda S M, Price H C. et al . Disposition of inhaled mercury vapor in pregnant rats: maternal toxicity and effects on developmental outcome.  Toxicol Sci. 2002;  66 261-273
• 46 Takahashi Y, Tsuruta S, Hasegawa J. et al . Release of mercury from dental amalgam fillings in pregnant rats and distribution of mercury in maternal and fetal tissues.  Toxicology. 2001;  163 115-126
• 47 Takahashi Y, Tsuruta S, Arimoto M. et al . Placental transfer of mercury in pregnant rats which received dental amalgam restorations.  Toxicology. 2003;  185 23-33
• 48 Vahter M, Akesson A, Lind B. et al . Longitudinal study of methylmercury and inorganic mercury in blood and urine of pregnant and lactating women, as well as in umbilical cord blood.  Environ Res. 2000;  84 186-194
• 49 Yoshida M, Satoh M, Shimada A. et al . Maternal-to-fetus transfer of mercury in metallothionein-null pregnant mice after exposure to mercury vapor.  Toxicology. 2002;  175 215-222
• 50 Yoshida M. Placental to fetal transfer of mercury and fetotoxicity.  Tohoku J Exp Med. 2002;  196 79-88
• 51 Drasch G, Aigner S, Roider G. et al . Mercury in human colostrum and early breast milk. Its dependence on dental amalgam and other factors.  J Trace Elem Med Biol. 1998;  12 23-27
• 52 Oskarsson A, Schultz A, Skerfving S. et al . Total and inorganic mercury in breast milk in relation to fish consumption and amalgam in lactating women.  Arch Environ Health. 1996;  51 234-241
• 53 Vimy M J, Hooper D E, King W W. et al . Mercury from maternal „silver” tooth fillings in sheep and human breast milk. A source of neonatal exposure.  Biol Trace Elem Res. 1997;  56 143-152
• 54 Leistevuo J, Leistevuo T, Helenius H. et al . Dental amalgam fillings and the amount of organic mercury in human saliva.  Caries Res. 2001;  35 163-166
• 55 Heintze U, Edwardsson S, Derand T. et al . Methylation of mercury from dental amalgam and mercuric chloride by oral streptococci in vitro.  Scand J Dent Res. 1983;  91 150-152
• 56 Yannai S, Berdicevsky I, Duek L. Transformations of inorganic mercury by Candida albicans and Saccharomyces cerevisiae.  Appl Environ Microbiol. 1991;  57 245-247
• 57 Wang J, Liu Z. [In vitro Study of Strepcoccus Mutans in the Plaque on the Surface of Amalgam Fillings on the Convertion of Inorganic Mercury to Organic Mercury].  Shanghai Kou Qiang Yi Xue. 2000;  9 70-72
• 58 Dodes J E. The amalgam controversy. An evidence-based analysis.  J Am Dent Assoc. 2001;  132 348-356
• 59 Jones D W. Exposure or absorption and the crucial question of limits for mercury.  J Can Dent Assoc. 1999;  65 42-46
• 60 Larkin M. Don’t remove amalgam fillings, urges American Dental Association.  Lancet. 2002;  3 360
• 61 Wahl M J. A biocompatible material for the new millennium: dental amalgam.  Dent Today. 2001;  20 16
• 62 Wahl M J. A resin alternative for posterior teeth: questions and answers on dental amalgam.  Dent Update. 2003;  30 256-262
• 63 Wahl M J. Amalgam revisited.  Dent Today. 2002;  21 16, 18
• 64 Wahl M J. Amalgam - Resurrection and redemption. Part 1: the clinical and legal mythology of anti-amalgam.  Quintessence Int. 2001;  32 525-535
• 65 Wahl M J. Amalgam - resurrection and redemption. Part 2: The medical mythology of anti-amalgam.  Quintessence Int. 2001;  32 696-710
• 66 Hargreaves R J, Evans J G, Janota I. et al . Persistent mercury in nerve cells 16 years after metallic mercury poisoning.  Neuropathol Appl Neurobiol. 1988;  14 443-452
• 67 Kosta L, Byrne A R, Zelenko V. Correlation between selenium and mercury in man following exposure to inorganic mercury.  Nature. 1975;  254 238-239
• 68 Opitz H, Schweinsberg F, Grossmann T. et al . Demonstration of mercury in the human brain and other organs 17 years after metallic mercury exposure.  Clin Neuropathol. 1996;  15 139-144
• 69 Sugita M. The biological half-time of heavy metals. The existence of a third, „slowest” component.  Int Arch Occup Environ Health. 1978;  41 25-40
• 70 Duhr E F, Pendergrass J C, Slevin J T. et al . HgEDTA complex inhibits GTP interactions with the E-site of brain beta-tubulin.  Toxicol Appl Pharmacol. 1993;  122 273-280
• 71 Pendergrass J C, Haley B E. Inhibition of Brain Tubulin-Guanosine 5’-Triphosphate Interactions by Mercury: Similarity to Observations in Alzheimer’s Diseased Brain. Sigel H, Sigel A, Dekker M Metal Ions in Biological Systems V34. Mercury and Its Effects on Environment and Biology New York; Inc. 270 Madison Ave 1996 chapter 16: 461-478,
• 72 Soares F A, Farina M, Santos F W. et al . Interaction between metals and chelating agents affects glutamate binding on brain synaptic membranes.  Neurochem Res. 2003;  28 1859-1865
• 73 Aposhian H V, Morgan D L, Queen H L. et al . Vitamin C, glutathione, or lipoic acid did not decrease brain or kidney mercury in rats exposed to mercury vapor.  J Toxicol Clin Toxicol. 2003;  41 339-347
• 74 Ewan K B, Pamphlett R. Increased inorganic mercury in spinal motor neurons following chelating agents.  Neurotoxicology. 1996;  17 34 334-34 339
• 75 Nogueira C W, Soares F A, Nascimento P C. et al . 2,3-Dimercaptopropane-1-sulfonic acid and meso-2,3-dimercaptosuccinic acid increase mercury- and cadmium-induced inhibition of delta-aminolevulinate dehydratase.  Toxicology. 2003;  184 85-95
• 76 Harris H H, Pickering I J, George G N. The chemical form of mercury in fish.  Science. 2003;  301 (5637) 1203
• 77 Fredriksson A, Dencker L, Archer T. et al . Prenatal coexposure to metallic mercury vapour and methylmercury produce interactive behavioural changes in adult rats.  Neurotoxicol Teratol. 1996;  18 129-134
• 78 Drasch G, Bose-O’Reilly S, Beinhoff C. et al . The Mt. Diwata study on the Philippines 1999 - assessing mercury intoxication of the population by small scale gold mining.  Sci Total Environ. 2001;  267 151-168
• 79 Drasch G, Bose-O’Reilly S, Maydl S. et al . Scientific comment on the German human biological monitoring values (HBM values) for mercury.  Int J Hyg Environ Health. 2002;  205 509-512
• 80 Schubert J, Riley E J, Tyler S A. Combined effects in toxicology - a rapid systematic testing procedure: cadmium, mercury, and lead.  J Toxicol Environ Health. 1978;  4 763-776
• 81 Viola P, Cassano G B. The effect of chlorine on mercury vapor intoxication. Autoradiographic study.  Med Lavoro. 1968;  59 437-444
• 82 Kommission Human Biomonitoring . Commentary regarding the article by Drasch et al. Scientific comment on the German human biological monitoring values (HBM values) for mercury.  Int J Hyg Environ Health. 2004;  207 179-181
• 83 Drasch G, Bose-Reilly S, Mydl S. et al . Response to the letter of the Human Biomonitoring Commission.  Int J Hyg Environ Health. 2004;  207 183-184
• 84 Bellinger D C, Needleman H L. Intellectual impairment and blood lead levels.  N Engl J Med. 2003;  349 500-502
• 85 Walkowiak J, Altmann L, Kramer U. et al . Cognitive and sensorimotor functions in 6-year-old children in relation to lead and mercury levels: adjustment for intelligence and contrast sensitivity in computerized testing.  Neurotoxicol Teratol. 1998;  20 511-521
• 86 Rogan W J, Ware J H. Exposure to lead in children - how low is low enough?.  N Engl J Med. 2003;  348 1515-1516
• 87 Canfield R L, Henderson C R Jr, Cory-Slechta D A. et al . Intellectual impairment in children with blood lead concentrations below 10 microg per deciliter.  N Engl J Med. 2003;  348 1517-1526
• 88 Selevan S G, Rice D C, Hogan K A. et al . Blood lead concentration and delayed puberty in girls.  Bethel J. N Engl J Med. 2003;  348 1527-1536
• 89 Lin J L, Lin-Tan D T, Hsu K H. et al . Environmental lead exposure and progression of chronic renal diseases in patients without diabetes.  N Engl J Med. 2003;  348 277-286
• 90 Glenn B S, Stewart W F, Links J M. et al . The longitudinal association of lead with blood pressure.  Epidemiology. 2003;  14 30-36
• 91 Boyd N D, Benediktsson H, Vimy M J. et al . Mercury from dental „silver” tooth fillings impairs sheep kidney function.  Am J Physiol. 1991;  261 R1010-R1014
• 92 Pollard K M, Pearson D L, Hultman P. et al . Xenobiotic acceleration of idiopathic systemic autoimmunity in lupus-prone bxsb mice.  Environ Health Perspect. 2001;  109 27-33
• 93 Akiyama M, Oshima H, Nakamura M. Genotoxicity of mercury used in chromosome aberration tests.  Toxicol In Vitro. 2001;  15 463-467
• 94 Pizzichini M, Fonzi M, Sugherini L. et al . Release of mercury from dental amalgam and its influence on salivary antioxidant activity.  Bull Group Int Rech Sci Stomatol Odontol. 2000;  42 94-100
• 95 Pizzichini M, Fonzi M, Sugherini L. et al . Release of mercury from dental amalgam and its influence on salivary antioxidant activity.  Sci Total Environ. 2002;  284 19-25
• 96 Pizzichini M, Fonzi M, Gasparoni A. et al . Influence of amalgam fillings on Hg levels and total antioxidant activity in plasma of healthy donors.  Bull Group Int Rech Sci Stomatol Odontol. 2001;  43 62-67
• 97 Olivieri G, Brack C, Muller-Spahn F. et al . Mercury induces cell cytotoxicity and oxidative stress and increases beta-amyloid secretion and tau phosphorylation in SHSY5Y neuroblastoma cells.  J Neurochem. 2000;  74 231-236
• 98 Olivieri G, Novakovic M, Savaskan E. et al . The effects of beta-estradiol on SHSY5Y neuroblastoma cells during heavy metal induced oxidative stress, neurotoxicity and beta-amyloid secretion.  Neuroscience. 2002;  113 849-855
• 99 Drasch G, Mail d er S, Schlosser C. et al . Content of non-mercury-associated selenium in human tissues.  Biol Trace Elem Res. 2000;  77 219-230
• 100 Bartova J, Prochazkova J, Kratka Z. et al . Dental amalgam as one of the risk factors in autoimmune diseases.  Neuroendocrinol Lett. 2003;  24 65-67
• 101 Berlin M. Mercury in dental-filling materials - an updated risk analysis in environmental medical terms. The dental Material Commission - Care and Consideration. 2003. Available from: URL: http://www.dentalmaterial.gov.se/mercury.pdf [cited 2003 September 22]. 
• 102 Hultman P, Johansson U, Turley S J. et al . Adverse immunological effects and autoimmunity induced by dental amalgam and alloy in mice.  FASEB J. 1994;  8 1183-1190
• 103 Hultman P, Lindh U, Horsted-Bindslev P. Activation of the immune system and systemic immune-complex deposits in Brown Norway rats with dental amalgam restorations.  J Dent Res. 1998;  77 1415-1425
• 104 Pollard K M, Pearson D L, Hultman P. et al . Xenobiotic acceleration of idiopathic systemic autoimmunity in lupus-prone bxsb mice.  Environ Health Perspect. 2001;  109 27-33
• 105 Stejskal J, Stejskal V D. The role of metals in autoimmunity and the link to neuroendocrinology.  Neuroendocrinol Lett. 1999;  20 351-364
• 106 Stejskal V D, Danersund A, Lindvall A. et al . Metal-specific lymphocytes: biomarkers of sensitivity in man.  Neuroendocrinol Lett. 1999;  20 289-298
• 107 Sterzl I, Prochazkova J, Hrda P. et al . Mercury and nickel allergy: risk factors in fatigue and autoimmunity.  Neuroendocrinol Lett. 1999;  20 221-228
• 108 Via C S, Nguyen P, Niculescu F. et al . Low-dose exposure to inorganic mercury accelerates disease and mortality in acquired murine lupus.  Environ Health Perspect. 2003;  111 1273-1277
• 109 Kazantzis G. Mercury exposure and early effects: an overview.  Med Lav. 2002;  93 139-147
• 110 Marcusson J A. The frequency of mercury intolerance in patients with chronic fatigue syndrome and healthy controls.  Contact Dermatitis. 1999;  41 60-61
• 111 Richardson G M. Assesment of Mercury Exposure and Risks from Dental amalgam. Final Report. Medical Devices Bureau, Health. Canada. Ottawa; 1995
• 112 Björklund G. Mercury as a potential source for the etiology of Alzheimer’s disease.  Trace Elem Med. 1991;  8 208
• 113 Ely J T. Mercury induced Alzheimer’s disease: accelerating incidence?.  Bull Environ Contam Toxicol. 2001;  67 800-806
• 114 Haley B. The relationship of toxic effects of mercury to exacerbation of the medical condition classified as Alzheimer’s disease.2002. Available from: URL: http://www.fda.gov/ohrms/dockets/dailys/02/Sep02/091 602/80027dd5.pdf [cited 2004 November 17]. 
• 115 Mutter J, Naumann J, Sadaghiani C. et al . Alzheimer Disease: Mercury as pathogenetic factor and apolipoprotein E as a moderator.  Neuroendocrin Lett. 2004;  25 (5) 275-283
• 116 Palkiewicz P, Zwiers H, Lorscheider F L. ADP-ribosylation of brain neuronal proteins is altered by in vitro and in vivo exposure to inorganic mercury.  J Neurochem. 1994;  62 2049-2052
• 117 Pendergrass J C, Haley B E. Inhibition of brain tubulin-guanosine 5’-triphosphate interactions by mercury: similarity to observations in Alzheimer’s diseased brain.  Met Ions Biol Syst. 1997;  34 461-478
• 118 Pendergrass J C, Haley B E. Mercury-EDTA Complex Specifically Blocks Brain-Tubulin-GTP Interactions: Similarity to Observations in Alzheimer’s Disease. Friberg LT, Schrauzer GN Status Quo and Perspective of Amalgam and Other Dental Materials. International Symposium Proceedings Stuttgart/New-York; Thieme 1995: 98-105
• 119 Pendergrass J C, Haley B E, Vimy M J. et al . Mercury vapor inhalation inhibits binding of GTP to tubulin in rat brain: similarity to a molecular lesion in Alzheimer diseased brain.  Neurotoxicology. 1997;  18 315-324
• 120 Leong C C, Syed N I, Lorscheider F L. Retrograde degeneration of neurite membrane structural integrity of nerve growth cones following in vitro exposure to mercury.  Neuroreport. 2001;  12 733-737
• 121 Cedrola S, Guzzi G, Ferrari D. et al . Inorganic mercury changes the fate of murine CNS stem cells.  FASEB J. 2003;  17 869-871
• 122 Godfrey M E, Wojcik D P, Krone C A. Apolipoprotein E genotyping as a potential biomarker for mercury neurotoxicity.  J Alzheimers Dis. 2003;  5 189-195
• 123 Ehmann W D, Markesbery W R, Alauddin M. et al . Brain trace elements in Alzheimer’s disease.  Neurotoxicology. 1986;  7 195-120
• 124 Thompson C M, Markesbery W R, Ehmann W D. et al . Regional brain trace-element studies in Alzheimer’s disease.  Neurotoxicology. 1988;  9 1-7
• 125 Wenstrup D, Ehmann W D, Markesbery W R. Trace element imbalances in isolated subcellular fractions of Alzheimer’s disease.  Brain Res. 1990;  533 125-131
• 126 Cornett C R, Ehmann W D, Wekstein D R. et al . Trace elements in Alzheimer’s disease pituitary glands.  Biol Trace Elem Res. 1998;  62 (1 - 2) 107-114
• 127 Samudralwar D L, Diprete C C, Ni B F. et al . Elemental imbalances in the olfactory pathway in Alzheimer’s disease.  J Neurol Sci. 1995;  130 139-145
• 128 Basun H, Forssell L G, Wetterberg L. et al . Metals and trace elements in plasma and cerebrospinal fluid in normal aging and Alzheimer’s disease.  J Neural Transm [P-D Sect]. 1991;  3 231-258
• 129 Hock C, Drasch G, Golombowski S. et al . Increased blood mercury levels in patients with Alzheimer’s disease.  J Neural Transm. 1998;  105 59-68
• 130 Braak H, Braak E, Yilmazer D. et al .Age-related changes of the human cerebral cortex. Cruz-Sanchez FF, Ravid R, Cuzner ML Neuropathological diagnostic criteria for brain banking Amsterdam; Biomedical Health Research IOS Press 1995: 14-19
• 131 Braak H, Griffing K, Braak E. Neuroanatomy of Alzheimer’s disease.  Alzheimer’s Res. 1997;  3 235-247
• 132 Braak E, Griffing K, Arai K. et al . Neuropathology of Alzheimer’s disease: what is new since A. Alzheimer?.  Eur Arch Psychiatry Clin Neurosci. 1999;  249 (Suppl 3) 14-22
• 133 Bickel H. Dementia syndrome and Alzheimer disease: an assessment of morbidity and annual incidence in Germany.  Gesundheitswesen. 2000;  62 211-218
• 134 Miech R A, Breitner J C, Zandi P P. et al . Incidence of AD may decline in the early 90 s for men, later for women: The Cache County study.  Neurology. 2002;  58 209-218
• 135 Haidinger G, Binder H, Kunze M. Epidemiologic progression of dementia diseases in Austria until the year 2050.  Gesundheitswesen. 1992;  54 162-166
• 136 Lund J P, Mojon P, Pho M. et al . Alzheimer’s disease and edentulism.  Age Ageing. 2003;  32 228-229
• 137 Saxe S R, Snowdon D A, Wekstein M W. et al . Dental amalgam and cognitive function in older women: findings from the Nun Study.  J Am Dent Assoc. 1995;  126 1495-1501
• 138 Ahlqwist M, Bengtsson C, Furunes B. et al . Number of amalgam tooth fillings in relation to subjectively experienced symptoms in a study of Swedish women.  Community Dent Oral Epidemiol. 1988;  16 227-231
• 139 Ahlqwist M, Bengtsson C, Lapidus L. et al . Serum mercury concentration in relation to survival, symptoms, and diseases: results from the prospective population study of women in Gothenburg, Sweden.  Acta Odontol Scand. 1999;  57 168-174
• 140 Ahlqwist M, Bengtsson C, Lapidus L. Number of amalgam fillings in relation to cardiovascular disease, diabetes, cancer and early death in Swedish women.  Community Dent Oral Epidemiol. 1993;  21 40-44
• 141 Bjorkman L, Pedersen N L, Lichtenstein P. Physical and mental health related to dental amalgam fillings in Swedish twins.  Community Dent Oral Epidemiol. 1996;  24 260-267
• 142 Finefrock A E, Bush A I, Doraiswamy P M. Current status of metals as therapeutic targets in Alzheimer’s disease.  J Am Geriatr Soc. 2003;  51 1143-1148
• 143 Ritchie C W, Bush A I, Mackinnon A. et al . Metal-protein attenuation with iodochlorhydroxyquin (clioquinol) targeting Abeta amyloid deposition and toxicity in Alzheimer disease: a pilot phase 2 clinical trial.  Arch Neurol. 2003;  60 1685-1691
• 144 Razagui I B, Haswell S J. Mercury and selenium concentrations in maternal and neonatal scalp hair: relationship to amalgam-based dental treatment received during pregnancy.  Biol Trace Elem Res. 2001;  81 1-19
• 145 Soderstrom S, Fredriksson A, Dencker L. et al . The effect of mercury vapour on cholinergic neurons in the fetal brain: studies on the expression of nerve growth factor and its low- and high-affinity receptors.  Brain Res Dev Brain Res. 1995;  85 96-108
• 146 Szasz A, Barna B, Gajda Z. et al . Effects of continuous low-dose exposure to organic and inorganic mercury during development on epileptogenicity in rats.  Neurotoxicology. 2002;  23 197-206
• 147 Bernard S, Enayati A, Roger H. et al . The role of mercury in the pathogenesis of autism.  Mol Psychiatry. 2002;  7 (Suppl 2) S42-S43
• 148 Geier D A, Geier M R. A comparative evaluation of the effects of MMR immunization and mercury doses from thimerosal-containing childhood vaccines on the population prevalence of autism.  Med Sci Monit. 2004;  10 PI33-39
• 149 Geier D A, Geier M R. An assessment of the impact of thimerosal on childhood neurodevelopmental disorders.  Pediatr Rehabil. 2003;  6 97-102
• 150 Geier M R, Geier D A. Neurodevelopmental disorders after thimerosal-containing vaccines: a brief communication.  Exp Biol Med. 2003;  228 660-664
• 151 Geier M R, Geier D A. Thiomersal in childhood vaccines, neurodevelopment disorders, and heart disease in the United States.  J Am Phys Surg. 2003;  8 6-11
• 152 Harakeh S, Sabra N, Kassak K. et al . Mercury and arsenic levels among Lebanese dentists: a call for action.  Bull Environ Contam Toxicol. 2003;  70 629-635
• 153 Tezel H, Ertas O S, Erakin C. et al . Blood mercury levels of dental students and dentists at a dental school.  Br Dent J. 2001;  191 449-452
• 154 Bittner A C Jr, Echeverria D, Woods J S. et al . Behavioral effects of low-level exposure to Hg0 among dental professionals: a cross-study evaluation of psychomotor effects.  Neurotoxicol Teratol. 1998;  20 429-439
• 155 Echeverria D, Heyer N J, Martin M D. et al . Behavioral effects of low-level exposure to elemental Hg among dentists.  Neurotoxicol Teratol. 1995;  17 161-168
• 156 Yoshida M, Watanabe C, Satoh M. et al .Susceptibility of Metallothionein-Null Mice to the Behavioural Alterations Caused by Exposure to Mercury Vapour at Human-Relevant Concentration. Toxicol Sci 2004 [Epub ahead of print]
• 157 Siblerud R L. A comparison of mental health of multiple sclerosis patients with silver/mercury dental fillings and those with fillings removed.  Psychol Rep. 1992;  70 1139-1151
• 158 Siblerud R L. The relationship between mercury from dental amalgam and mental health.  Am J Psychother. 1989;  43 575-587
• 159 Siblerud R L, Kienholz E, Motl J. Evidence that mercury from silver dental fillings may be an etiological factor in smoking.  Toxicol Lett. 1993;  68 307-310
• 160 Siblerud R L, Motl J, Kienholz E. Psychometric evidence that mercury from silver dental fillings may be an etiological factor in depression, excessive anger, and anxiety.  Psychol Rep. 1994;  74 67-80
• 161 Urban P, Gobba F, Nerudova J. et al . Color discrimination impairment in workers exposed to mercury vapor.  Neurotoxicology. 2003;  24 711-716
• 162 Aydin N, Karaoglanoglu S, Yigit A. et al . Neuropsychological effects of low mercury exposure in dental staff in Erzurum, Turkey.  Int Dent J. 2003;  53 85-91
• 163 Ngim C H, Foo S C, Boey K W. et al . Chronic neurobehavioural effects of elemental mercury in dentists.  Br J Ind Med. 1992;  49 782-790
• 164 Ritchie K A, Gilmour W H, Macdonald E B. et al . Health and neuropsychological functioning of dentists exposed to mercury.  Occup Environ Med. 2002;  59 287-293
• 165 Nadorfy-Lopez E, Torres S H, Finol H. et al . Skeletal muscle abnormalities associated with occupational exposure to mercury vapours.  Histol Histopathol. 2000;  15 673-682
• 166 Urban P, Lukas E, Nerudova J. et al . Neurological and electrophysiological examinations on three groups of workers with different levels of exposure to mercury vapors.  Eur J Neurol. 1999;  6 571-577
• 167 Meyer-Baron M, Schaeper M, Seeber A. A meta-analysis for neurobehavioural results due to occupational mercury exposure.  Arch Toxicol. 2002;  76 127-136
• 168 Dunsche A, Frank M P, Luttges J. et al . Lichenoid reactions of murine mucosa associated with amalgam.  Br J Dermatol. 2003;  148 41-748
• 169 Dunsche A, Kastel I, Terheyden H. et al . Oral lichenoid reactions associated with amalgam: improvement after amalgam removal.  Br J Dermatol. 2003;  148 70-76
• 170 Martin M D, Broughton S, Drangsholt M. Oral lichen planus and dental materials: a case-control study.  Contact Dermatitis. 2003;  48 331-336
• 171 Wong L, Freeman S. Oral lichenoid lesions (OLL) and mercury in amalgam fillings.  Contact Dermatitis. 2003;  48 74-79
• 172 Guttman-Yassky E, Weltfriend S, Bergman R. Resolution of orofacial granulomatosis with amalgam removal.  J Eur Acad Dermatol Venereol. 2003;  17 344-347
• 173 Gerhard I, Monga B, Waldbrenner A. et al . Heavy metals and fertility.  J Toxicol Environ Health A. 1998;  54 593-611
• 174 Gerhard I, Runnebaum B. [The limits of hormone substitution in pollutant exposure and fertility disorders].  Zentralbl Gynakol. 1992;  114 593-602
• 175 Gerhard I, Waibel S, Daniel V. et al . Impact of heavy metals on hormonal and immunological factors in women with repeated miscarriages.  Hum Reprod Update. 1998;  4 301-309
• 176 Rowland A S, Baird D D, Weinberg C R. et al . The effect of occupational exposure to mercury vapour on the fertility of female dental assistants.  Occup Environ Med. 1994;  51 28-34
• 177 Sheiner E K, Sheiner E, Hammel R D. et al . Effect of occupational exposures on male fertility: literature review.  Ind Health. 2003;  41 55-62
• 178 Podzimek S, Prochazkova J, Pribylova L. et al . [Effect of heavy metals on immune reactions in patients with infertility].  Cas Lek Cesk. 2003;  142 285-288
• 179 Frustaci A, Magnavita N, Chimenti C. et al . Marked elevation of myocardial trace elements in idiopathic dilated cardiomyopathy compared with secondary cardiac dysfunction.  J Am Coll Cardiol. 1999;  33 1578-1583
• 180 Lorscheider F, Vimy M. Mercury and idiopathic dilated cardiomyopathy.  J Am Coll Cardiol. 2000;  35 819-820
• 181 Guallar E, Sanz-Gallardo M I, van’t V eer P. et al . Heavy Metals and Myocardial Infarction Study Group. Mercury, fish oils, and the risk of myocardial infarction.  N Engl J Med. 2002;  347 1747-1754
• 182 Salonen J T, Seppanen K, Nyyssonen K. et al . Intake of mercury from fish, lipid peroxidation, and the risk of myocardial infarction and coronary, cardiovascular, and any death in eastern Finnish men.  Circulation. 1995;  91 645-655
• 183 Moreira C M, Oliveira E M, Bonan C D. et al . Effects of mercury on myosin ATPase in the ventricular myocardium of the rat.  Comp Biochem Physiol C Toxicol Pharmacol. 2003;  135C 269-275
• 184 de Assis G P, Silva C E, Stefanon I. et al . Effects of small concentrations of mercury on the contractile activity of the rat ventricular myocardium.  Comp Biochem Physiol C Toxicol Pharmacol. 2003;  134 375-383
• 185 South P K, Morris V C, Levander O A. et al . Mortality in mice infected with an amyocarditic coxsackievirus and given a subacute dose of mercuric chloride.  J Toxicol Environ Health A. 2001;  63 511-523
• 186 Boffetta P, Sallsten G, Garcia-Gomez M. et al . Mortality from cardiovascular diseases and exposure to inorganic mercury.  Occup Environ Med. 2001;  58 461-466
• 187 Siblerud R L. The relationship between mercury from dental amalgam and the cardiovascular system.  Sci Total Environ. 1990;  99 23-35
• 188 Craelius W. Comperative epidemiology of multiple sclerosis and dental caries.  Journal of Epidemiol Comm Health. 1978;  32 155-165
• 189 McGrother C W, Dugmore C, Phillips M J. et al . Multiple sclerosis, dental caries and fillings: a case-control study.  Br Dent J. 1999;  187 261-264
• 190 Baasch E. Theoretical considerations on the etiology of multiple sclerosis. Is multiple sclerosis a mercury allergy?.  Schweiz Arch Neurol Neurochir Psychiatr. 1966;  98 1-19
• 191 Ingalls T H. Epidemiology, etiology, and prevention of multiple sclerosis. Hypothesis and fact.  Am J Forensic Med Pathol. 1983;  4 55-61
• 192 Ingalls T H. Endemic clustering of multiple sclerosis in time and place, 1934 - 1984. Confirmation of a hypothesis.  Am J Forensic Med Pathol. 1986;  7 3-8
• 193 Issa Y, Watts D C, Duxbury A J. et al . Mercuric chloride: toxicity and apoptosis in a human oligodendroglial cell line MO3.13.  Biomaterials. 2003;  24 981-987
• 194 Ahlrot-Westerlund B. Mercury in cerebrospinal fluid in multiple sclerosis.  Swed J Biol Med. 1989;  1 6-7
• 195 Siblerud R L, Kienholz E. Evidence that mercury from silver dental fillings may be an etiological factor in multiple sclerosis.  Sci Total Environ. 1994;  142 191-205
• 196 Huggins H A, Levy T E. Cerebrospinal fluid protein changes in multiple sclerosis after dental amalgam removal.  Altern Med Rev. 1998;  3 295-300
• 197 Engel P. [Observations on health before and after amalgam removal].  Schweiz Monatsschr Zahnmed. 1998;  108 811-813
• 198 Prochazkova J, Sterzl I, Kucerova H. et al . The beneficial effects of amalgam replacement on health of patients with autoimmunity.  Neuroendocrinol Lett. 2004;  25 211-218
• 199 Casetta I, Invernizzi M, Granieri E. Multiple sclerosis and dental amalgam: case-control study in Ferrara, Italy.  Neuroepidemiology. 2001;  20 134-137
• 200 Bangsi D, Ghadirian P, Ducic S. et al . Dental amalgam and multiple sclerosis: a case-control study in Montreal, Canada.  Int J Epidemiol. 1998;  27 667-671
• 201 Bates N M, Fawcett J, Garrett N. et al . Health effects of dental amalgam exposure: a retrospective cohort study.  Int J Epidemiol. 2004;  33 894-902
• 202 Pamphlett R, Slater M, Thomas S. Oxidative damage to nuclic acids in motor neurons containing mercury.  J Neurol Sci. 1998;  159 121-126
• 203 Pamphlett R, Waley P. Motor neuron uptake of low dose inorganic mercury.  J Neurol Sci. 1996;  135 63-67
• 204 Adams C R, Ziegler D K, Lin J T. Mercury intoxication simulating amyotrophic lateral sclerosis.  JAMA. 1983;  250 642-643
• 205 Schwarz S, Husstedt I, Bertram H P. et al . Amyotrophic lateral sclerosis after accidental injection of mercury.  J Neurol Neurosurg Psychiatry. 1996;  60 698
• 206 Rehde O, Pleva J. Recovery from amyothrophic lateral sclerosis and from allergy after removal of dental amalgam fillings.  Int J Risk Safety Med. 1994;  4 229-236
• 207 Lindh U, Hudecek R, Danersund A. et al . Removal of dental amalgam and other metal alloys supported by antioxidant therapy alleviates symptoms and improves quality of life in patients with amalgam-associated ill health.  Neuroendocrinol Lett. 2002;  23 459-482
• 208 Marcusson J A. Psychological and somatic subjective symptoms as a result of dermatological patch testing with metallic mercury and phenyl mercuric acetate.  Toxicol Lett. 1996;  84 113-122
• 209 Marcusson J A, Jarstrand C. Oxidative Metabolism of neutrophils in vitro and human mercury intolerance.  Toxicol In vitro. 1998;  12 383-388
• 210 Marcusson J A, Carlmark B, Jarstrand C. Mercury intolerance in relation to superoxide dismutase, glutathione peroxidase, catalase, and the nitroblue tetrazolium responses.  Environ Res. 2000;  83 123-128
• 211 Stewart W F, Schwartz B S, Simon D. et al . ApoE genotype, past adult lead exposure, and neurobehavioral function.  Environ Health Perspect. 2002;  110 501-505
• 212 Hol P J, Vamnes J S, Gjerdet N R. et al . Dental amalgam and selenium in blood.  Environ Res. 2001;  87 141-146
• 213 Lindh U, Carlmark B, Gronquist S O. et al . Metal exposure from amalgam alters the distribution of trace elements in blood cells and plasma.  Clin Chem Lab Med. 2001;  39 134-142
• 214 Stejskal V D, Forsbeck M, Cederbrant K E. et al . Mercury-specific lymphocytes: an indication of mercury allergy in man.  J Clin Immunol. 1996;  16 31-40
• 215 Valentine-Thon E, Schiwara H W. Validity of MELISA for metal sensitivity testing.  Neuroendocrinol Lett. 2003;  24 57-64
• 216 Bauer A, Alsen-Hinrichs C, Wassermann O. [Evaluation of environmental medicine documentation in Schleswig-Holstein 1995 - 1999].  Gesundheitswesen. 2001;  63 231-237
• 217 Hamre H J. Amalgam. Stuttgart; Hippokrates-Verlag 1997
• 218 Kidd R F. Results of dental amalgam removal and mercury detoxification using DMPS and neural therapy.  Altern Ther Health Med. 2000;  6 49-55
• 219 Melchart D, Wuhr E, Weidenhammer W. et al . A multicenter survey of amalgam fillings and subjective complaints in non-selected patients in the dental practice.  Eur J Oral Sci. 1998;  106 770-777
• 220 Berlin M. Mercury in dental-filling materials - an updated risk analysis in environmental medical terms. The dental Material Commission- Care and Consideration. 2003. Available from: URL: http://www.dentalmaterial.gov.se/mercury.pdf [cited 2003 September 22]: 19. 
• 221 Engel P. Migräne- eine unheilbare Krankheit? 2003. Available at URL: http://www.amalgam-info.ch/mig_d.pdf [cited 16.1.04]. 
• 222 Bailer J, Staehle H J, Rist F. [Ill due to amalgam? 10 rules for managing the symptomatic patient].  MMW Fortschr Med. 2003;  145 34-38
• 223 Bailer J, Rist F, Rudolf A. et al . Adverse health effects related to mercury exposure from dental amalgam fillings: toxicological or psychological causes?.  Psychol Med. 2001;  31 255-263
• 224 Wassermann O, Weitz M, Alsen-Hinrichs C. Kieler Amalgamgutachten 1997. Institut für Toxikologie. Kiel; Christian-Albrechts-Universität 1997 2. Aufl
• 225 Ruprecht J. Dimaval (DMPS)/DMPS-Heyl - wissenschaftliche Produktmonographie. 6. aktualisierte und erweiterte Auflage. 1997
• 226 Price W A. Nutrition and physical degeneration. 6th edition. McGraw Hill; NTC 1998
• 227 Saxe S R, Wekstein M W, Kryscio R J. et al . Alzheimer’s disease, dental amalgam and mercury.  J Am Dent Assoc. 1999;  130 191-199
• 228 Walach H, Naumann J, Mutter J. et al . No difference between self-reportedly amalgam sensitives and non-sensitives? Listen carefully to the data.  Int J Hyg Environ Health. 2003;  206 139-141
• 229 Mutter J, Daschner F D. Commentary regarding the article by Gottwald et al.: „Amalgam disease” - poisoning, allergy, or psychic disorder?.  Int J Hyg Environ Health. 2003;  206 69-70
• 230 Burton D. Consumer Choice and implementing full disclosure in dentistry „... Amalgam must be considered to be an unsuitable material for dental restoration”. 2003. Available at URL. http://www.house.gov/burton/pr5703 [cited 16.1.04]. 
• 231 Burton D. Mercury in Medicine-Taking unnecessary Risks. 2003. Available at URL. http://www.house.gov/burton/pr5203 [cited 16.1.04]. 
• 232 House of Representatives .H.R. 1680: A Bill. Mercury in Dental Filling Disclosure and Prohibition Act. 2003. Available at URL: http://thomas.loc.gov/cgi-bin/query/z?c108: H.R.1680.IH: [cited 16.1.04]. 
• 233 ADA .H.R. 1680. Association urges House members to reject amalgam-banning legislation. 2003. Available at URL: http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid = 235 [cited 20.2.2004]. 
• 234 BfArM (Bundesinstitut für Arzneimittel und Medizinprodukte) .Amalgame in der zahnärztlichen Therapie. 2003. Available from: URL: http://www.bfarm.de/de/DasBfArM/publ/Broschuere_Amalgame.pdf [cited 2003 November 6]. 
• 235 Harhammer R. Zur Risikobewertung des zahnärztlichen Füllungswerkstoffes Amalgam.  Bundesgesundhbl. 2001;  44 149-154
• 236 Larkin M. Don’t remove amalgam fillings, urges American Dental Association.  Lancet. 2002;  360 393
• 237 Yip H K, Li D K, Yau D C. Dental amalgam and human health.  Int Dent J. 2003;  53 464-468
• 238 UNEP (United Nations Environment Program (Chemicals) .Global Mercury Assesment. UNEP Chemicals Geneva. 2002. Available from: URL: http://www.unep.org/GoverningBodies/GC22/Document/UNEP-GC22-INF3.pdf [cited 2003 September 22]. 
• 239 Schober S E, Sinks T H, Jones R L. et al . Blood mercury levels in US children and women of childbearing age, 1999 - 2000.  JAMA. 2003;  289 1667-1674
• 240 Bender M T. Dentists the menace? The uncontrolled release of dental mercury. Mercury policy project. 2002. Available from: URL: http://www.mercurypolicy.org/new/documents/DentistTheMenace.pdf [cited 2003 September 22]. 
• 241 Department o f Ecology Publication. Draft for public comment. Washington State mercury chemical action plan. 2002. Available from: URL: http://www.ecy.wa.gov/pubs/0 203 042.pdf [cited 2003 December 16]. 
• 242 Stone M E, Cohen M E, Liang L. et al . Determination of methyl mercury in dental-unit wastewater.  Dent Mater. 2003;  19 675-679
• 243 Leistevuo J, Leistevuo T, Helenius H. et al . Mercury in saliva and the risk of exceeding limits for sewage in relation to exposure to amalgam fillings.  Arch Environ Health. 2002;  57 366-370
• 244 Künzler P, Andrée M. More mercury from crematoria.  Nature. 1991;  349 746-747
• 245 Maloney S R, Phillips C A, Mills A. Mercury in the hair of crematoria workers.  Lancet. 1998;  352 1602
• 246 Mills A. Mercury and crematorium.  Nature. 1990;  346 615
• 247 Kornhuber H H. Prevention of dementia (including Alzheimer’s disease).  Gesundheitswesen. 2004;  66 346-351
• 248 Life Science Research Office .Final Report. 2004. Available from: URL: http://www.Lsro.org/amalgam/frames_amalgam_report.html [cited 2005, January 22]+;.